What Clinicians Need to Know about PTSD

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What Clinicians Need to Know about PTSD

Posttraumatic Stress Disorder (PTSD) has become a household term in the United States as society has placed an increased emphasis on improving care for war veterans. Public perception hasn't begun to conceptualize that PTSD affects more than just the military population. Practically any life-threatening or severely emotional event can lead to posttraumatic stress and about 20% of survivors will develop PTSD. 1.2  

Civilian vs. Military PTSD

To break the numbers down, seven per cent of the U.S. population are military veterans and, according to 2010 Census data, this adds up to 3, 241, 809 veterans that will develop PTSD in their lifetime. 3,4 When looking at the entire U.S. population and subtracting out the veterans, 17, 752, 868 civilians will develop PTSD.4 This means that civilians with PTSD outnumber veterans by more than five times. Causes include car wrecks, accidents, fires, natural disasters and serious crimes such as sexual assault.

History of PTSD Diagnosis and Treatment

Since the diagnosis of PTSD was created in the 1980 publication of the third edition of the Diagnostic and Statistical Manual (DSM-III) or psychiatric disorders, the number of Vietnam era veterans with PTSD has continued to rise. While awareness of its existence has become commonplace, access to trained, licensed treatment providers has been limited. 5,6 There has been a lot of research and debate about the most effective treatment, but clinicians are forced to navigate what amounts to 101 trauma-informed interventions to choose the skill set to learn.7 The result in this evolution of our knowledge or PTSD is a scenario where therapists across the country have learned one of these various approaches to PTSD , perhaps because that's what they had the opportunity to learn or they had an affinity for it. Now they've gotten used to what they are doing and have become rather inflexible with regard to adopting new therapies that are proven to be more effective.8

Trauma Affects People Differently

In 2013, the American Psychiatric Association recognized that PTSD doesn't affect everyone in the same way.9 Some overreact to the stress and live in fear with excess adrenaline, sweating, increased heart rate, nightmares and suffer the long-term consequences of heart disease and stroke. Others have been so emotionally hurt and depressed that they find themselves withdrawn, socially isolated and defeated. These extremes can occur in the same person at different time points in the course of their illness. Therefore the clinician needs to be able to assess the subtypes of PTSD entering their clinic and have a variety of research-based treatments that fits the situation, rather than using a "one size fits all" approach.

PTSD Treatment Modality Selection Tool

The 9-Line PTSD Test was created to take into account the Capacity, Opportunity, and Motivation states-to make an assessment of both the strengths and weaknesses of each of these domains. Then, to intersect these states on a 3x3 grid to the three basic attitudinal, emotional, and genetic endophenotypes: Overreactive, Underreactive, and Normoreactive.

9-Line PTSD Test

The result is an intuitive, easy to understand grid-mapping algorithm that generates a free, individualized PDF report for your patient to bring to an appointment-or do the 9-question survey on their phone or laptop right there in your office. Here are a few of the benefits.

Benefits of the 9-Line PTSD Test

  1. A logical explanation is readily available for both you and your patient to help start out on the right therapy with shared goals.
  2. Much of your informed consent time can be supplemented with PTSD Academy resources and explanations.
  3. Have a roadmap for what to do with patients that you're unable to help, with full explanations provided to the patient.

9 Line PTSD Test



  1. Henry L, Y, Brackbill RM DiGrande, Pulliam P, Galea s. posttraumatic stress symptoms among long-term 3.271 civilian survivors of the September 11, 2001, terrorist attacks on the World Trade Center. Am. J. Epidemiol. 2011; 173 (3): 271-281.
  2. DiGrande L, Perrin MA, Thorpe LE, et al. Posttraumatic stress symptoms, PTSD, and risk factors among lower Manhattan residents 2 – 3 years after the September 11, 2001 terrorist attacks. J. Trauma. Stress. 2008; 21 (3): 264-273.
  3. Martinez L, Bingham a. US veterans: By the numbers. Abc News. 2011; 11.
  4. Gradus JL. Epidemiology of PTSD. Researchers, Providers and Helpers 2016; http://www.ptsd.va.gov/professional/PTSD-overview/epidemiological-facts-ptsd.asp. Accessed Dec. 18, 2016, 2016.
  5. Elnitsky CA, Andresen EM, Clark ME, McGarity S, Hall CG, Kerns Rd. Access to the US Department of Veterans Affairs health system: self-reported barriers to care among returnees of Operations Enduring Freedom and Iraqi Freedom. BMC health services research. 2013; 13 (1): 1.
  6. Erbes CR, Stinson R, Kuhn E, et al. Access, utilization, and interest in mHealth applications among veterans receiving outpatient care for PTSD. Mil. Med. 2014; 179 (11): 1218-1222.
  7. Curran LA. 101 Trauma-Informed Interventions: Activities, Exercises and Assignments for Moving the Client and Therapy Forward. Eau Caire, WI: Premiere Publishing & Media; 2013.
  8. Lilienfeld SO, Ritschel LA, Lynn SJ, Cautin RL, Latzman Rd. Why many clinical psychologists are resistant to evidence-based practice: Root causes and constructive remedies. Clin. Psychol. Rev. 2013; 33 (7): 883-900.
  9. Friedman MJ. Finalizing PTSD in the DSM-5: Getting here from there and where to go next. J. Trauma. Stress. 2013; 26 (5): 548-556.
  10. MORLAND LA, Mack M-A, Greene CJ, et al. Cognitive processing therapy for posttraumatic stress disorder delivered to rural veterans via telemental health: A randomized noninferiority clinical trial. The Journal of clinical psychiatry. 2014; 75 (5): 470-476.
  11. Lauckner C, Whitten P, Holtz B. When technology alone is not enough: A discussion of a struggling telepsychiatry project and lessons from model programs. Paper presented at: Collaboration Technologies and Systems (CTS), 2014 International Conference on2014.
  12. Doyle JM, Streeter RA. Veterans ' Location in Health Professional Shortage Areas: Implications for Access to Care and Workforce Supply. Health Serv. Res. 2016.
  13. Affairs DoV. Expanded Access to Non-VA Care Through the Veterans Choice Program. Final rule. Fed. Registrat. 2015; 80 (209): 66419.
  14. Pietrzak RH, Johnson DC, Goldstein MB, Malley JC, Southwick SM. Perceived stigma and barriers to mental health care utilization among OEF-OIF veterans. Psychiatr. Serv. 2015.
  15. Murray D. ETMC, PTSD Patient Raise Awareness Through Christmas Tree Lighting. 2016; http://www.kltv.com/story/33820498/etmc-ptsd-patient-raise-awareness-through-christmas-tree-lighting. Accessed Dec. 22, 2016, 2016.


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